John, you obviously don’t understand the coding system. From its inception the L Code System has been an add on system with a base code and additions to describe additional features not included in the base code. These add on codes reflect the added cost of evaluation, materials, fabrication time and patient instruction time to provide these additions. For example, the addition of dorsiflexion assist to an AFO only reflects the additional costs of using dorsiflexion assist joints. The amount allowed for this procedure does not represent the total cost for providing a dorsiflexion assist joint only the additional cost, or the difference between the standard free motion ankle and the dorsiflexion assist joint.
As a P.T. you should understand that ultimately the only thing we have for sale is our time. It is appropriate that we be reimbursed for anything that causes us more time (expense) to provide an orthosis and increases the effectiveness of the orthosis to address a documented need.
John Hatch, CPO
Date: Fri, 26 Mar 2004 13:08:09 EST
From: “John Wall PT,CPO”
Subject: Re: Coding
These were excellent examples of why we are in trouble with payers. If I
were on the payroll of the payers most of these people would be up on charges for
fraud. We are concerned about PTs, OTs, BOC? After those coding examples,
we better police ourselves or we will code ourselves out of work.
John Wall PT, CPO, FAAOP
